CVNT 2 > Poisons > Flashcards

Poisons Flashcards

(49 cards)

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1
Q

when to suspect intoxication

A
  • usually acute onset
  • often accidental (human meds, overdose, exposure to toxins at home)
  • usually oral ingestion, can be topical
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2
Q

phone assessment questions

A
  • what, when, dose
  • up-to-date body weight
  • call VPIS if needed
  • avoid house calls
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3
Q

owner instructions for emergency admit

A
  • bring product label, photo
  • sample of product
  • try to prevent self grooming if dermal toxin
  • do not follow internet remedies
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4
Q

before owner arrival

A
  • consult VPIS/others for up-to-date management advice
  • prep for triage (catheter, oxygen, decontaminants, emetics)
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5
Q

primary survey

A
  • respiratory
  • cardiovascular
  • neurological
  • renal/urogenital
  • pain
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6
Q

diagnosing intoxication

A
  • history, clinical suspicion
  • toxin panel (blood, gastric contents)
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7
Q

managing intoxication general principles

A
  1. remove/eliminate toxin
  2. reduce ongoing absorption
  3. dilution of toxin
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8
Q

options for removing/eliminating toxin

A
  1. induce emesis
  2. gastric lavage (reserved for patients where emesis doesn’t work)
  3. cutaneous decontamination
  4. haemodialysis
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9
Q

induction of emesis

A
  • empties 40-60% gastric contents
  • indicated within 2-3hrs oral ingestion
  • possibly effective >3hrs post-ingestion with substances that coalesce
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10
Q

contraindications of inducing emesis

A
  • if patient is seizing, unconscious
  • if intoxicant is corrosive, irritant
  • if petroleum distillate is ingested
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11
Q

emetic agent for dogs

A
  • apomorphine (subcut)
    • long lasting (anti-emetic after)
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12
Q

emetic agent for cats

A
  • xylazine (IM) effective in <50%
    • use reversal agent after
    • used as sedative
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13
Q

gastric lavage considerations

A
  • uncommon
  • known significant intoxication within the last 1hr
  • and induction of emesis unsuccessful or contraindicated
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14
Q

potential complications of gastric lavage

A
  • induce anaesthesia (risks)
  • aspiration pneumonia
  • gastro-oesophageal trauma
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15
Q

gastric lavage steps

A
  • anaesthetised patient in left lateral recumbency
  • measure nares to last rib, lube tube tip
  • lavage with 10-30ml/kg warmed saline
  • kink tube prior to removal to prevent spilling of contents
  • suction oropharynx prior to recovery
  • ensure swallow reflex returned prior to extubation
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16
Q

cutaneous decontamination

A
  • clip affected regions in long-haired patients
  • warm water, mild shampoo
  • degreasing agents if necessary
  • avoid ocular contamination
  • prevent patient grooming
  • do not neutralise acids/alkali
  • do not use alchol/solvents
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17
Q

haemodialysis

A
  • extracorporeal therapy
  • renal replacement
  • very unavailable
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18
Q

reducing ongoing absorption methods

A
  • enteric adsorbents (activated charcoal)
  • intralipid (IV)
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19
Q

enteric adsorbents

A
  • reduces ongoing absorption and facilitates faecal excretion of toxin
  • liquid/powder
  • not effective for all toxins
  • repeated admin for enterohepatic recirculation cases
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20
Q

complications for enteric adsorbents

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A
  • not effective for all toxins
  • can cause black faeces, constipation
  • may cause GIT irritation
21
Q

intralipid IV

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A
  • creates lipid sink, holding lipids in intravascular space preventing its effect on the brain
  • not effective for all toxins
22
Q

complications of intralipid (IV)

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A
  • toxin must be lipophilic
  • can cause fat embolization, pancreatitis
23
Q

supportive care for poison patients

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A
  • specific antidote
  • maintain hydration and nutrition
  • manage nausea, pain
  • turn recumbent patients regularly
  • lubricate eyes for patients with reduced blink
24
Q

special considerations for neurotoxins

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A
  • manage seizures
  • check no metabolic cause
  • monitor gag reflex
25
which ingestants not to worry about
- contraceptive pill (GI upset) - silica gel - catnip exposure - novelty luminous items (hypersalivation)
26
clinical signs of nephrotoxin ingestion
- sudden onset - signs of AKI - inappetence - lethargy - vom, diarrhoea
27
diagnosis of nephrotoxin ingestion
- azotemia - calcium oxalate monohydrate crystals in ethylene glycol toxicity
28
common nephrotoxins
- NSAIDs - lilies (cats) - grapes, raisins (dogs) - ethylene glycol (antifreeze) - vitamin d analogues (renal calcification)
29
nephrotoxin management
- decontamination (induce emesis, activated charcoal, wash) - specific antidotes for some toxins
30
nephrotoxin nursing considerations
- maintain euhydration and euvolaemia - monitor fluid ins/outs - often nauseous- antiemetics - analgesia - hypertension common
31
clinical signs of neurotoxins
- hyper-excitability, agitation - tachycardia, arrhythmias - muscle tremors (risk of hyperthermia_ - seizures - obtundation
32
common neurotoxins
- theobromine (chocolate) - permethrin (spot-on) on cats - metaldehyde (slug pellets) - tremorogenic mycotoxins (mould) - canabis
33
management of neurotoxins
- decontaminate (emesis, activated charcoal, wash) - muscle relaxants (diazepam) - anti-epileptics - ensure no hypoglycaemia, calcaemia - intra-lipid treatment
34
neurotoxin nursing considerations
- regular turning for obtunded patients - toileting considerations - monitor for seizures, tremors - monitor gag reflex
35
common hepatotoxins
- xylitol (artificial sweetner) - mushrooms - blue green algae - alfatoxins (found in mould) - drugs
36
considerations for hepatotoxins
- monitor for hypoglycaemia, coagulopathy - may develop hepatic encephalopathy
37
how do anticoagulant rodenticides cause coagulopathies?
- impacting vitamin K dependant clotting factors (II, VII, IX, X) - produced in the body in inactive form - become active through carboxylation (Vit K) - Vit K becomes inactive (oxidised) - can be reduced through Vit K-epoxide reductase - anticoagulant rodenticides block Vit K-epoxide reductase - inactive clotting factors can no longer be activated
38
presentation of anticoagulant rodenticide
- pre-symptomatic- witnessed ingestion - takes 2-5 days to develop symptoms) - symptomatic- severe coagulopathy - haemoabdomen/haemothorax - collapse, hypovolaemic, anaemic - indirect toxicity due to ingestion of dead rats is unlikely
39
witnessed ingestion of rat bait- treatment
- GI decontamination (emesis, activated charcoal) - measure clotting times (PT, aPTT) immediately and 48hrs after - Vit K1 therapy - repeat PT, aPTT post-treatment
40
treatment of symptomatic anticoagulant rodenticide
- care when taking bloods - too late for decontamination - Vit K1 therapy - plasma, RBC, replacement of clotting factors
41
methaemoglobinaemia
- caused by paracetamol toxicity in cats - oxidative damage to RBC - iron should be Fe2+ state to bind to O2, oxidative damage causes Fe3+ (methaemoglobin)
42
clinical signs of methaemoglobinaemia
- chocolate coloured mucous membranes - brown blood
43
clinical signs of paracetamol toxicity in cats
- methaemoglobinaemia- reduced O2 delivery, signs of shock - cardiorespiratory distress - neurological signs - facial and limb oedema
44
treatment of paracetamol toxicity
- induce emesis if ingested <1hr, no contraindications - activated charcoal - anti-oxidants (N-acetylcysteine)
45
clinical signs of adder bite
- usually within 2hrs - puncture wounds - swelling, bruising local to bite - altered mentation- depressed) - panting, pyrexia - +/- cardiac arrhythmias
46
treatment of adder bite
- keep patient quiet and calm - leave bite well alone - antivenom - analgesia - fluid therapy?
47
common irritant/caustic substances
- batteries - benzalkonium chloride (disinfection) - petrolleum distillate - washing tablets
48
clinical signs of caustic substances
- oral ulceration- pain, hypersalivation, anorexia - oesophageal ulceration- regurgitation - gastric ulceration- vomiting - dermal alopecia, burns, ulceration
49
treatment of caustic substances
- gut decontamination contraindicated - dermal decontamination (warm water rinse) - analgesia (opioids) - maintain hydration - tube feeding (bypass ulcerated areas) - radiograph to locate battery
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